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Radv Audit Jobs (NOW HIRING)

Mercor

HCC Coding Leader - Risk Adjustment

New York, NY · Remote

$110/hr

Manage RADV audit preparation and response processes. * Collaborate with clinical, coding, and compliance teams to improve documentation and coding for risk adjustment purposes. Qualifications Must ...

Mass Advantage

Manager, Risk Adjustment

Worcester, MA · On-site

Lead RADV audit readiness and response, including medical record retrieval, validation, submission strategy, and cross-functional coordination with Legal, Compliance, and Finance to mitigate ...

ICON Consultants, Inc.

Certified Medical Coder

$23 - $31.50/hr

The ideal candidate will have extensive experience performing CMS and HHS RADV audits, vendor-side coding reviews, and risk adjustment auditing while maintaining exceptional coding accuracy and ...

Alignment Healthcare

VP, Internal Audit

Orange, CA

Together. The VP, Internal Audit is a highly visible senior leadership role responsible for ... Drawing on deep expertise in Medicare Advantage risk adjustment, RADV compliance, and encounter ...

Alignment Healthcare

VP, Internal Audit

Orange, CA · On-site

Together. The VP, Internal Audit is a highly visible senior leadership role responsible for ... Drawing on deep expertise in Medicare Advantage risk adjustment, RADV compliance, and encounter ...

Careers Integrated Resources Inc

Medical Coder III

$27/hr

CMS RADV Medical Reviewer Guidance (1/10/2020). Top Skills Required: Must have prior experience with CMS Contract Level Risk Adjustment Data Validation Audits (RADV) and HHS RADV audits and IPM ...

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Radv Audit information

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$25K

$71.8K

$108K

How much do radv audit jobs pay per year?

As of Aug 15, 2026, the average yearly pay for radv audit in the United States is $71,776.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,500.00 and $81,500.00 per year, depending on experience, location, and employer.

What are some common challenges faced by professionals in a RADV audit role, and how can they be addressed?

Professionals in a Radv Audit role often encounter challenges such as managing tight deadlines, navigating complex regulatory requirements, and ensuring accuracy in documentation. Collaborating closely with cross-functional teams and maintaining clear communication with stakeholders can help mitigate misunderstandings and streamline the audit process. Staying updated with current industry standards and leveraging audit management tools are also crucial for maintaining efficiency and compliance. Proactively seeking feedback and participating in continuous learning opportunities can further enhance performance in this role.

What is a RADV audit?

A RADV (Risk Adjustment Data Validation) Audit is a process used by the Centers for Medicare & Medicaid Services (CMS) to verify the accuracy of diagnosis codes submitted by Medicare Advantage organizations. The purpose is to ensure that health plans are being compensated appropriately based on the health status of their members. During a RADV audit, patient medical records are reviewed to confirm that the diagnoses used for risk adjustment are supported by documentation. This helps prevent overpayments and ensures compliance with federal regulations. Organizations found to have unsupported diagnoses may be required to repay funds to CMS.

What is the difference between Radv Audit vs Radv Analyst?

AspectRadv AuditRadv Analyst
CertificationsCPA, CIA, CISACPA, CIA, CISA
Work EnvironmentAudit firms, corporate audit departmentsFinancial institutions, consulting firms
Primary FocusEvaluating internal controls, compliance, and financial accuracyAnalyzing risk, data, and financial reports to support audits

Radv Auditors primarily focus on evaluating internal controls and ensuring compliance through audits, while Radv Analysts analyze data and risks to support audit processes. Both roles require similar certifications and often work in related environments, but their core responsibilities differ in scope and focus.

What key skills and qualifications are needed to thrive as a RADV auditor, and why are they important?

To excel as a RADV (Risk Adjustment Data Validation) Auditor, you need a solid understanding of medical coding, healthcare regulations, and risk adjustment methodologies, typically supported by credentials like CPC, CRC, or RHIA. Familiarity with audit software, electronic health records (EHRs), and CMS guidelines is essential. Strong analytical thinking, attention to detail, and effective communication are important soft skills for interpreting data and conveying findings. These skills ensure accurate validation of medical records, compliance with regulatory standards, and the integrity of healthcare reimbursement processes.
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What cities are hiring for Radv Audit jobs?

Cities with the most Radv Audit job openings:

What states have the most Radv Audit jobs?

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What job categories do people searching Radv Audit jobs look for?

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Radv Audit jobs near you
Infographic showing various Radv Audit job openings in the United States as of August 2026, with employment types broken down into 80% Full Time, and 20% Contract. Highlights an 80% In-person, and 20% Remote job distribution, with an average salary of $71,776 per year, or $34.5 per hour.

Remote | HCC Risk Adjustment Coding Consultant Up to $85/hour

24-Mag Llc

Remote

$85/hr

Other

Posted 5 days ago

Job description

Specialised Part-Time Consulting Opportunity

We are sharing a specialised part-time consulting opportunity for United States-based healthcare coding and risk adjustment professionals experienced in HCC coding, Medicare Advantage risk adjustment, Medicaid managed care, ACA risk adjustment, RADV audit preparation, medical record review, documentation capture, and coding compliance.

This role supports current and upcoming remote consulting opportunities focused on AI-assisted risk adjustment coding evaluation, HCC recommendation review, documentation completeness assessment, and high-quality project execution. Selected professionals will apply coding and risk adjustment expertise to evaluate AI-generated HCC assignments, review documentation support, identify coding inaccuracies, and provide structured feedback based on detailed project criteria.

Key Responsibilities

Professionals in this role may contribute to:

  • Risk Adjustment & HCC Coding Review
  • Chart Review, RADV & Risk Score Evaluation
  • Structured Coding Feedback & Quality Control
Risk Adjustment & HCC Coding Review
  • Review risk adjustment coding workflows across Medicare Advantage, Medicaid managed care, and ACA risk adjustment programs
  • Evaluate AI-generated HCC coding assignments and risk adjustment recommendations for clinical accuracy, documentation support, and regulatory compliance
  • Review medical records to determine whether HCC-eligible conditions are fully and accurately supported by clinical documentation
  • Identify coding inaccuracies, unsupported diagnoses, documentation gaps, missed HCC opportunities, and compliance concerns
Chart Review, RADV & Risk Score Evaluation
  • Assess retrospective and prospective chart review outputs for completeness, accuracy, and risk score relevance
  • Evaluate outputs related to CMS-HCC, RxHCC, and ACA HHS-HCC methodologies
  • Support review of RADV audit preparation, audit response workflows, and risk adjustment data validation requirements
  • Review risk adjustment KPIs such as HCC capture rates, risk score accuracy, chart retrieval rates, and coding quality indicators
Structured Coding Feedback & Quality Control
  • Annotate AI-generated coding and risk adjustment outputs and provide structured feedback to support quality improvement
  • Explain review decisions clearly, consistently, and with strong coding and compliance judgment
  • Evaluate outputs for alignment with CMS risk adjustment guidance, ICD-10-CM coding standards, Official Coding Guidelines, RAPS, EDGE submissions, and applicable compliance expectations
  • Follow detailed task instructions, quality criteria, and project-specific review guidelines accurately
Ideal Profile

Strong candidates may have:

  • 5+ years of experience in risk adjustment coding, HCC coding, Medicare Advantage coding operations, or related healthcare coding workflows
  • At least 2 years of leadership experience in risk adjustment, HCC coding, coding quality, chart review, or coding operations
  • Deep expertise in CMS-HCC, RxHCC, and/or ACA HHS-HCC risk adjustment methodologies
  • Strong knowledge of ICD-10-CM coding guidelines as applied to risk adjustment and HCC documentation
  • Experience with RADV audit preparation, CMS compliance requirements, chart retrieval workflows, and risk adjustment quality review
  • Familiarity with RAPS and EDGE submission processes
  • Exceptional written and verbal English communication skills
  • High attention to detail and ability to identify coding inaccuracies, unsupported diagnoses, and documentation gaps in AI-generated outputs
Educational Background

Professional background in risk adjustment coding, HCC coding, medical coding, health information management, Medicare Advantage operations, managed care coding, value-based care, or coding compliance is highly relevant

  • Experience in health plans, Medicare Advantage organizations, Medicaid managed care organizations, provider groups, value-based care organizations, or coding vendor environments may be especially valuable
  • Practical experience with chart review systems, coding platforms, risk adjustment analytics tools, EHR documentation, and audit workflows may support project fit
  • Formal education or training in health information management, medical coding, healthcare administration, nursing, clinical documentation, or a related healthcare field may be relevant depending on project scope
Nice to Have
  • CRC, CCS, CPC, RHIA, or similar coding or health information credential
  • Experience with risk adjustment analytics platforms, chart retrieval systems, coding quality tools, or AI-assisted HCC coding workflows
  • Background in health plan, Medicare Advantage, accountable care, or value-based care risk adjustment operations
  • Familiarity with AI tools and comfort evaluating AI-generated risk adjustment and HCC coding content
  • Experience presenting risk adjustment performance, coding quality findings, or documentation improvement opportunities to actuarial, compliance, clinical, or executive teams
  • Strong ability to identify risk score integrity issues, documentation improvement opportunities, and coding compliance risks
Why This Opportunity
  • Apply HCC coding and risk adjustment expertise to structured remote healthcare project work
  • Contribute to high-quality AI-assisted risk adjustment coding and documentation review
  • Use coding leadership, audit preparation experience, and compliance judgment in a focused review environment
  • Work on flexible assignments aligned with Medicare Advantage, managed care, ACA risk adjustment, and value-based care expertise
  • Remote structure with competitive hourly compensation
Contract Details
  • Independent contractor role
  • Fully remote with flexible scheduling
  • United States-based professionals are required for this opportunity
  • Part-time project-based commitment depending on availability, onboarding status, and project needs
  • Competitive rates of up to $85 per hour depending on risk adjustment experience, HCC coding expertise, leadership background, and project scope
  • Weekly payments via Stripe or Wise
  • Projects may be extended, shortened, or adjusted depending on scope and performance
  • Work will not involve access to confidential or proprietary information from any employer, client, or institution
About the Platform

This opportunity is available through 24-MAG LLC. We connect experienced professionals with remote consulting opportunities across technical, evaluation, and project-based workstreams.

By submitting this application, you acknowledge that your information may be processed by 24-MAG LLC for recruitment and opportunity matching in accordance with our Privacy Policy: https://www.24-mag.com/privacy-policy.

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